Menopause

Question 1

What is menopause?

Answer 1

A retrospective diagnosis made after a woman has had no periods for 12 months. It is defined as a permanent end to menstruation.

Question 2

What is the average age of menopause?

Answer 2

51 years

Question 3

Define post-menopause.

Answer 3

The period from 12 months after the final menstrual period.

Question 4

What is peri-menopause?

Answer 4

The time leading up to menopause and the first 12 months following menopause.

Question 5

What physiological changes occur during menopause?

Answer 5

1. Decline in ovarian follicles
2. Reduced oestrogen production
3. Oestrogen no longer suppressing release of LH and FSH from pituitary
4. Anovulation and amenorrhoea

Question 6

List some perimenopausal symptoms caused by lack of oestrogen.

Answer 6

• Hot flush
• Emotional lability or low mood
• Irregular periods
• Joint pains
• Heavier or lighter periods
• Vaginal dryness and atrophy
• Reduced libido

Question 7

What are some risks associated with lack of oestrogen?

Answer 7

• CVD and stroke
• Osteoporosis
• Pelvic organ prolapse
• Urinary incontinence

Question 8

How is menopause diagnosed?

Answer 8

Clinical diagnosis of perimenopause and menopause made in women >45 years with typical symptoms.

Question 9

What does NICE (2015) recommend for diagnosing menopause?

Answer 9

FSH blood test for:
* Women <40 years with suspected premature menopause
* Women 40-45 years with menopausal symptoms or a change in menstrual cycle

Question 10

At what age does fertility begin to decline?

Answer 10

After 40 years old

Question 11

How long should contraception be used after the last menstrual period?

Answer 11

• 2 years for women <50 years
• 1 year for women >50 years

Question 12

What are contraception methods with no restrictions?

Answer 12

• Barrier methods
• Mirena or copper coil
• Progesterone only pill
• Progesterone implant
• Progesterone depot injection (<45 years)
• Sterilisation

Question 13

What are some contraception methods with mild risks?

Answer 13

• COCP (unsuitable > 50 years)
  
  • Venous thromboembolism
• Depo-Provera (unsuitable > 45 years)
  
  • Weight gain
  • Reduced bone mineral density (osteoporosis)

Question 14

What is the expected duration for vasomotor symptoms to resolve?

Answer 14

2-5 years

Question 15

List management options for menopausal symptoms.

Answer 15

• No treatment
• HRT
• Tibolone (synthetic hormone acting as continuous HRT, only after 12 months amenorrhoea)
• Clonidine
• CBT
• SSRIs
• Testosterone (for libido, gel or cream)
• Vaginal oestrogen (cream or tablets)
• Vaginal moisturisers